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tv   Dr. Kelli Harding The Rabbit Effect  CSPAN  October 10, 2019 1:25am-2:18am EDT

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amazon, google and uber. good evening and tha >> good evening welcome and for a little bit of history the store was started by my grandfather in 1927 and my father passedd away as part of
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new york famous book row that ran along fourth avenue from astor place to union square with 48 used bookstores that competed with one another they have all shuddered except for the strand so thank you for a shifts readers we are still family owned and thriving in fact 400 events and discussions just like tonight and even tonight we have four events it is really fun. [applause] and also thank you c-span for filming this. happiness is the best medicine
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us some large enough to send every family of four check of $40000 for their care and happiness is not a big ticket item. our guest tonight doctor harding will discuss this as an assistant professor of psychiatry at columbia university medical center and diplomat to the american board of psychiatry and neurology work in the emergency room at the new york presbyterian hospital and as a daughter of a 91 -year-old i spend a lot of timeld there so i have a lot of admiration. she has appeared on good morning america netscape and u.s. news & world report. doctor harding is here. [applause] starting with the story with a
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groundbreaking new research thatws shows how community and environment and the purpose could have a greater impact on our health than anything that happened in a doctors office. doctor harding in conversation as an adjunct professor at the columbia school of public health and for 12 years the chief medical officer the nation's largest state mental health agency where he continues as a distinguished psychiatric advisor. the addictions solution
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ertreating the dependency and opiates and other drugs. inso a family guide to mental health care, please welcome doctors harding to the strand for thisan important discussion. [cheers and applause] >> first of all thank you with that introduction and it such an honor to be at the samee bookstore really i did not
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grow up in new york but the strand has a mystique to it if you are sitting here among the books it is just really the highlights of my life. thank you so much and to be surrounded by so many people that i absolutely love. this is an incredibles treat for going to see so many faces from so many different periods. thank you so much. because this is a book about kindness just want to take one second and say hello to your neighbor and say hello to your neighbor. >> good evening. we wanted to get to know you
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as ourkn guests a little bit more. how many of you are scientist? how many are from the mental health field? how many are writers? journalists? they are a special form of writers. how many are here tonight because you are a relative? [laughter] how many are here because you are her neighbor and you rely on her medical advice? [laughter] and we think this is a book about vampires?
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but it is not it must be in another room. >> and some of you probably wondert what is the deal with the rabbit. that.l talk about >> so let's learn more about you, kelly. we have heard you have a pretty busy life as emergency room doctor, youou have three childre children, how in the world do you gather the time and energy to write this book? >> i have to say this book is an incredibly important message i know many in the room know this but it became something that was so urgent to get the message out i know this is something you also share aet passion about public
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health or is an important story we are not talking about that affects every single person in thisin room. >> so tell us about the rabbits. [laughter] >> the central characters. >> so before i get to the rabbits i want to say something as a clinician raise your hand again. as clinicians there is a lot of mystery with the mismatch between what we expect with the disease and what actually transpires in life and in the hospital so those that have a serious diagnosis on paper they are not doing well but then you meet them and they are functioning and doing and living their life fully on the flipside those maybe if you look at the labs and imaging
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it looks okay but they are not functioning. this mystery propelled me through many years of education psychiatrist thought it was the mind-body connection i ended up better research fellowship looking at medically unexplained symptoms i did not have a full answer until i heard about the rabbits. >> so this was part of your discovery of what you had been searching for. >> exactly. one of my mentors at harvard told me i thank you might want to hear about these rabbito studies. i heard something about the social world impact but didn't know the details so i searched and i finally tracked down the
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rabbits of the late seventies. the studies were done with the intention of looking at heart health and rabbits at the time it wasn't known if a high-fat diet made a difference to heart health they were all genetically the same in the fed the high-fat diet read the results something was wrong one had far better health out outcomes than the others in the scientist said there was something wrong with the protocol but everything checked out so they looked at who was caring for the rabbits one was a very caring woman pwho is actually picking up the rabbits not just giving them avkibble that loving them and talking to them and they realize that could it be the social environment changes
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their physiology. to their credit because that was a radical idea at the time they replicated the study with tightly controlled physicians with the exact same results so a lot of the studies are serendipitous but this is an example because this is groundbreaking to show the social world has an impact but it was just the beginning of a much bigger story. >> and then this is the nature of really good science if it doesn't make sense you don't dismiss it you pursue it and that's what they did. so that protective effect the nurture that the colony of
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rabbits received protected them from disease. that is a phenomenal thing to discover. >> so the fact that somehow the social world is changing our physiology and that defies our understanding of how the body works but then thinking about the mechanism the main thing is we now have four decades ofnc science since then that shows to the field of public health that shows how the social world impacts all of our lives every single person in this room are listening on tv they are impacted of the kindness they are giving others and receiving. it comes back to so many different factors related to mental health and that's where we enter the discussion. >> you say these are hidden
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factors. are they yet to be discovered? what is hidden? >> with the social determinants or social dimensions but the thing to keep in mind it's always the things in the day-to-day relationships what happens in our homes, workplace schools, communitie schools, communities, neighborh broaderto social environment, it comes down to how we take care of one another. so this raises the point that i want to take a second to think about kindness in real life so in my life flushes take a second and think about somebody who is shown you
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kindness recently just for a couple seconds. now for me this exercise is very easy now i'm looking at a sea of people sitting next to me. but kindness makes us feel good but there is emerging science it's really cool how the body works and how the social world is changing who we are. >> so you say these moments of kindness are going to make a difference and it seems like such a rich resource.
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>> actually am curious to your thoughts why do you think it is so underused? >> i will let you get away with that. [laughter] >> honestly after i wrote my book, he sent me a book it covers a lot of the same things there are all the secrets that are headed in plain sight basically. it's hard sometimes to take science and implement that day today with the mindset so thein goal of the book i realize when i started the school of public health this is information that needs to be in every single person's hands because they need to recognize their actions do matter. it turns out a bigger predictor of her health by far is yourct workplace. we think of health like diet
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and sleep in exercise of the trip to the doctor but not really our workplace as having such an important impact or the neighborhood or access to food or those stress h levels. and it's a conversation we need to talk about because the other piece is mental health and t that has a lot of stigma for sure and you have seen it firsthand throughout your career. >> yet another public health problem is loneliness how do you connect loneliness to the problems with our health and
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helping one another and kindness? >> it comes down to taking care of one another. as a society were not doing a great job in loneliness is a big piece. there's all this data that loneliness is as detrimental to your health such as smoking 15 cigarettes per day or alcohol use or high blood pressure how many times does your doctor ask if you drink or smoke that when's the last time you called a good friend or saw someone you cared about? do you have someone to reach out to? it turns out that is critical. >> have you gotten a hard time from your colleagues that we are missing the boat asking about smoking or drinking that
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we are missing the relationship parts of our lives. is that a hard time quick. >> i would love to hear from colleagues in the room about thisth but i was just talking about this with the medical students there is record numbers of burnout with physicians those that work in medical care a big piece of that the current system is not acknowledging the major determinant of our health which brings me to a statistic. medical care is only about ten or 20 percent of our overall health. but yet when it comes to how much we spend on healthcare and how we think about 95 percent ofre dollars are on medical care and
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administrative cost. that being said it is important access to medical care is critical but at the same time we have to see the bigger picture of health and that includes our communities thinking of the school system and all these other things that are minimized with biomedicine. >> is a hard to be kind? what are the barriers. [laughter] what gets in the way? >> so in my experience writing the book kindness is a practice and it's something you have to do every single day we fail that it but it's
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recognizing we can continually strive for. not talking about grand measures of kindness by looking the person who gives you the coffee in the morning to say good morning and human decency and how we treat other people through society for those that are not as fortunate as we are. >> is kindness different from niceness? >> that's a good question i don't know the answer. [laughter] >> once again i have to answer my own question. >> i think they are closely related i think in the public health world or the medical world when we talk about all the social factors, it boils
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down to one of the great pleasures of writing this book was hearing my wonderful editor to say how do you talk about this to people who weren't scientists or academics? it really came down to kindness because that is the golden thread and it has a ripple effect because if you act with kindness to someone else you just feel good when somebody smiles at you or do something nice or puts a hand on your shoulder or somebody that has your back we know those things they make us feel better but now increasingly get the science to show it we have to do more of that. i just feel so lucky because
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this room is filled with people who have had my back i am just so grateful and gratitude is also good for health. >> that's another important idea that you have advanced that is gratitude tell us about the practice of gratitude. >> what is really neat is it dovetails not just kindness to yourself but also to others in an easy way to do that is start with gratitude. when we think about that person that was kind to us increasingly the studies show that mindfulness and gratitude is good for our body. it comes down to stress we know that is inevitable i like how you talk about stress in your work and we have to think
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about buffers because it's a big part of the book to build up our reserves and resilience that when it comes up it doesn't knock us on the floor. >>. the inflammatory process is a phenomenon and it essential to the development of disease and disability. how was kindness and antidote to anti-inflammatory whsponse? help us understand. >> this is some of the coolest science the neuro- immune system us not understanding how that was working to explain with theti patients i was seeing they are not feeling well but we can't find something wrong on the traditional path because the
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test don't measure the right things necessarily. but also what is cool is in this country we separate the mind and the body in a very physical way with mental hhealth with places of care but we don't think of people there is a doctor for every bit of your body we've gotten so specialized on the one hand it's helpful but we still need to step back and look at the bigger picture it with these conversations happening in bookstores and communities around the country. >> are you asked to coach my friends how to talk to their doctor about the inflammatory response or kindness or those social factors that determine
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health? how do people know how to bring this up with their doctor quick. >> it's fascinating i am curious to hear your response but people will say have this one doctor who is phenomenal and asking these types of questions like the way people currently they don't ask about their social life in a ten minute focused visit and that's if you aref lucky that feels like opening the lid of pandora's box. so the key way that i talk about raise your hand if you are familiar with aces. i am impressed. so one of the things are experiences that happen that
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are present in our environment like smoking in the forties people really didn't think it caused lung cancer took many years to figure f out this is causing diseases across the board. so trauma is one of those and etwe don't really talk about it many doctors don't know about it but there is an easy test you can take online called the aces is too high with a history of trauma but every other person you pass on the street has some history of trauma in their past there is a lot of shame and stigma so people don't talk about it but it comes back to the question so what do you do if somebody is unkind? because hurt people hurt people if somebody isn't present but that is part of the story because people think
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kindness is great until suddenly there is a structural situation or somebody yells or cut you off in traffic but actually it's about conflict resolution navigating our world to hear other people's differences in the way that we can problem solve and that were not doing a good job of that right now and for our society and health frankly we need to have moreav conversations where we can create a bridge. >> that's a good concept what are examples of the experiences that children have that leave them with this residue for the rest of their lives? >> i'm glad you mentioned
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that. anything during childhood could have a lifetime consequence when it comes to health the first study was an incidental finding that was too curious to let go so what is so interesting is mike the loss of a parent or witnessing abuse or the things you would think about harshly talk to but what is empowering is having some ability to come in all different modalities address the traumas that they have.
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>> and these are traumas that can be identified early in a child's life. when that happens what can be done to help spare the child the problem quick. >> a lot of this work is done in california is not just happening in the clinic seeee you identify aces and from there a lot of the resources are things in our community but this isn't what we are supporting with the current healthcare system but a lot of interventions make a huge difference on health are low-cost the rabbit effect are things you don't have to have a white coat and the vast majority of the program you just have to have the good intention there is a lot of
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peer health educator program so there's ways to get i involved this is just one example of hundreds so it turns out volunteering is good for your health. you live longer. and then to get involved in. do we ha teachers in the room? awesome. pictures that you are really in the healthcare business so the statistic was mind boggling for every one life saved with biomedicine education saved eight. but it turns out you really don't need a white coat to help people.
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i have incredible students in the room i don't want to minimize that but i also want to say and then to participate whether you know whethers or not. so now i'm really making a point to reach out to people when i see someone in need i don't necessarily walk by the think of something creative. >> so now the writing and then the speaking that has changed you spend with the biggest changes in the last week. i was sharing earlier i didn't
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think anybody would show up but someone with us we were shopping the idea around and said kindness doesn't sell. incredibly heartwarming it turns out fallout of my chair because of it but people do care about kindness because rat a critical point of the communities where we talk about p it. of that important change will require all of that. >> that's very good message to leave us with and maybe now there are some comments or questions from our guests.
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>> so now we get to get copies for everybody we know. >> thankfo you. >> i am a happiness engineer. i do this. so this response relationship on kindness receiving or giving. [laughter] >> that raises the important point because we talk about how people are in a lot off pain if they look for a pill or to the doctors office you just have to do the google search why do i feel so tired or alone?
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that won't necessarily come in a pill we can overdose on but i can't remember a single case in the emergency room somebody overdosed on kindness. [laughter] >> may be a somebody is mentally ill on the street what should you do? >> so doctor stutter ran mental health in new york state for over a decade. 's the first i would start with is honestly your safety comes first that you want to ask their name. are you okay? do you want me to call somebody?
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those are the things i typically do. it is often the same people. how could it be that we are in this glorious city with incredible resources but yet so many peoplele are still on the streets who are not getting adequate treatment. heah program they are doing an awesome job with it on the foundation with lady .in her mom, sort of training people up to be able to address issues of mental health and in a more systematic way because again it isn't just a guy on the street. hard at school, the guy
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it's all those people we need to be creating a more inclusive community with. >> so many of us may be tongue-tied at the moment with somebody that is in distress. there was a campaign in australia. a very simple question for everybody in the country and the campaign was called are you okay. i think what you are describing. and also, the first person experience. when you ask somebody not only are you okay, but what is your name. >> this brings the human element cribing. >> that is exactly it and it's getting at that human element because it is so easy to other people and so whatever the
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circumstance whether it is somebody on the street or somebody that doesn't necessarily shame to -- share the same political views is just easier to put people in another camp and it's probably how we have survived overtime, but we also have these incredible brains that can help us overcome that and the key is recognizing these hidden factors and also recognizing your actions are having a profound effect and i think that some of the most lovely piece of this is that sometimes just one action of kindness can make a real difference in somebody's life in a way that you may not ever anticipate. one thing i felt very fortunate as a clinician is sometimes people will come back and say you really made a difference when you did this one thing and i think i can't believe it because it isn't always appreciated at the time. so, -- >> of their comments or
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questions? >> we've been mostly talking about the kindness therapy or whatever you want to call it with normal folks. now curious how does the kindness therapy training with somebody that is psychotic or in the hospital, schizophrenic, how does that work? >> that is a really good question. >> is a great question. >> i think we also have to look at how we are treating people in the hospitals because raise your hand if you have ever stayed in any sort of hospital or care for somebody in a hospital, i know i have. sometimes it is easy to lose the person getting the medical care, the human being involved for all the medical care. so, part of that is by design,
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but we also have to really be thinking about the humanistic element of the person that is getting the care and i think we can do a lot better job. some of that research comes looking at how medical care is delivered in other countries. i think we are starting to make inroads to it because it used to be this like visiting hours were cut off at certain times, but now it is much more inclusive because people often do better in the family is by their side. i see a lot of heads shaking. it makes so much sense like in other countries that is often ie norm and it's now become the norm here. so, for westernized medicine just to come back to the big population data again, we are really not doing a good job, we are spending a huge amount of money but at the same time when you look at our outcomes they are really not where they need to be, like across the board we are just not doing as well as a lot of other wealthy countries are doing when it comes to rates of obesity, premature death,
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high blood pressure, homicide, suicide, all these things. we need to acknowledge that we are missing a big piece of the puzzle. so, again i think if you asked me earlier how clinicians respond, i dream a lot of positive support from clinicians because i think that they are recognizing that we all are into medicine to help care for people and to really fix the problem that failed a patient if you are not addressing some of this. >> i'm wondering about the connection between mindfulness and kindness as you were explaining because if we talk about just taking the time to look someone in the eye and say thank you for the cup of coffee i think in new york we are in this and go go go kind of mode and i want your thoughts on the connection between that and kindness. >> said, mindfulness, there's probably experts in the room that are mor more in this than ,
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but there is compelling data now beyond just niceness there's also a meditatio meditation pra, gratitude practices, there is a whole buffet of different mindful practices that you can pick and choose what works for you and your lifestyle or anything. i think actually the meditation able to clinicians i hear joking it's like we all know the data it is just overwhelmingly good, but to actually sit down and be still for ten minutes, 20 minutes a day it is very hard. it takes practice. i would say just number one there's the data showing that it's very helpful for health and it's also because it is reducing the stress level it's having now it is like a cascade of epigenetic changes. there's this cool research.
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it used to be like your genes were your destiny that now there is this science that shows they are much more invaluable than we realize that it is because of the way that they are sort of like folding and responding to the environment and there are the school studies where it is basically showing that you can make positive changes even somebody that is living with illness based on doing things right mindfulness practices and lowering your risk of recurrent stroke or heart disease. that is incredible. the data if it came as a pill every one would take it. it's so robust that it's because it requires a practice it isn't necessarily an easy fix. >> but it's very inexpensive. >> it is. hello, thank you so much. >> what is your name? >> stephanie. >> there are so many just to
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that point there are so many applications out there right now whether it is called more simple habit or any of those. is there one that you like in particular any sort of way to look at it that you think is good? >> i would say to do what works for you because of th if the kes just to practice element of it, i tried a bunch of them and in fact actually with my kids we got like a band across the head where it shows your pain wave and there is some cool ones out there. i've had a lot of friends tell me different ones work that you don't even necessarily need an application. you can just practice even stillness for five minutes and it makes a big and, it's really amazing. we are a go-go culture. good evening. thank you for a lovely evening in new york. >> hell did you hear about the
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here and i'm kind of stuck on what to do for my last night so i thought i would invest in a book. [applause] i have an 18 hour train journey tomorrow so this will come in handy. [laughter] i'm just interested in what you think if there is a coalition between bicultural inclusivity in the sense that certainly when it comes to politics in britain at the moment struggling with the disaster and that is certainly like i've seen in my society of a huge division between people, and we have become and a lot of people didn't have the correct information, there's a lot of fear for some people and it was even, you know, walking around some areas of new york such cultural diversity. but a lot of it is very sector
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is and i wonder if you thi creating cultural inclusivity in the part of the program or with regards to politics. i feel like politicians kind of separate us and there's a public sole factor to kind of addres that. >> i would say this is actually probably topic number one when it comes to public health and many of the med students the audience know that you are talking about health disparities and how able are treated differently in the hospitals. it's pretty unbelievable, and it isn't always over. it's often done with sort of the best of intentions that when you look at the data in fact we were just talking tth that showed sur african-american patients versus white patients were like over 70% more likely to recommend imputation versus for the white
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patients. that kind of data is like even okay there's a margin of error by 20% it is still totally unacceptable. so, that is probably a really big area. one of the things i talk about in the book is also our unconscious biases. it's something that we probably everybody's got them. i talk about and about some of them i discovered which the medical students take. the test isn't perfect to show that you are biased in this way that the idea can just get you thinking that maybe you are doing things like micro- aggression or other things that may be harmful because micro mio aggressions are the sort of pulled equivalent of death by a thousand paper cuts. >> we have time for two more questions. >> hello, kelly. >> hello. i haven't read the book yet but i look forward to it.
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do you talk about the impact of the internet and how that disconnects us. while the ups can be helpful if you look for the younger generation especially we talk about how it is a lonely generation, the increase of loneliness and the impact that it has. did you look at that at all or think about that? >> that comes into play particularly there is an early chapter on our one-to-one relationships. we are all doing this incredible experiment with our children right now, so i think they just called it as very on the huffington is calling its generation alpha so it is our first generation that's really grown up as my kids age and many of the people in the rooms kids age where they have never not known technology. but there are these really interesting well-known studies
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like looking at your phone and not looking at another human face has all these downstream consequences and we are doing it pretty much every day to each other. just next time you are on the subway, look around and you will notice how few people are not engaging with one another they are just sort of sitting and looking at their phones. you will now see a couple of dictating which i think is pretty cool. but it's actually got something for me that has changed a lot and trying to be much more intentional about my phone usage. it's hard because it's like then you end up totally behind on e-mail and not seeing some important messages. as a society we are kind of grappling with it and i certainly don't have a solution that but i would say let's keep working on it because again the face-to-face interaction is the most critical thing. i think in lieu of the last question actually we have one more question.
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>> hello, gabrielle. one, as an individual going through trauma as a child undiagnosed, what would be some suggestions you have for them now as an adult and then the second half of that is if you do see an adult or child in trauma what are some suggestions as a friend or family member that we can do for them? >> what a wonderful question. the first step would be to actually dig into some of the resources and that is a good thing to think about being a mental health professional. so, but luckily if you are here in new york city, there are a lots of it is a good thing. and they can give you or anyone options that are tailored to their needs. the second piece of it is when it comes to childhood actually the most innovative clinics are giving things that are involving -- because it is and the doctor's responsibility to take care of all of this. we need more interdisciplinary teams. this is something psychiatry has
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done for decades. they are quite good at is that even getting better and that is a thing we need to be investing in social work. we've got experts social work people in the room we need to be investing in more therapists and a more pure health educators and using things that are evidence-based to try to reduce that. there are some in terms of trauma that doesn't necessarily involve a therapist some amazing studies looking even at the power of writing and how that can make a difference. writing things for like 15 minutes a day for three days in a row has been significantly shown to reduce the stress around. so it's pretty amazing that these interventions are out there, but the key thing for us i guess as to just start talking about them and look for solutions together because it is a big topic. it's a big book. we cover it a lot. actually if it is okay the last thing i would like to do in closing is just to think, also may be what you might do
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tomorrow morning to offer a little kindness to somebody in a different way than you were expecting and if you could turn to your neighbor and offer them a little kindness like thank you for coming or something like that. >> thank you so much for coming. [inaudible c
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mechanics. >> welcome, everybody. thank you very much for coming. i'm delighted to see you all here. i'm a faculty member at the economic department and one of the cochairs of the task force that was commissioned by the president a year ago last spring and the purpose of the task force is to sort of engage and come front the sense that many have bee in the labor market technology is changing rapidly to understand why people are


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